A dose of 25 Gy in 5 fractions was delivered as short-course radiotherapy, with one fraction per day, completing treatment within one week. The target volume was delineated using both CT and MRI. Compared to conventional radiotherapy fields, the irradiated volume was significantly reduced to include only the primary tumor and any metastatic lymph nodes as identified on MRI and CT.

Reduced-field short-course radiotherapy

After completion of radiotherapy, chemotherapy with the XELOX regimen (oxaliplatin 130 mg/m² on day 1 plus capecitabine 1500 mg/m² on days 1-14, every 3 weeks) was initiated in combination with sintilimab immunotherapy (200 mg every 3 weeks) for 4 cycles.

Immunotherapy combined with chemotherapy

Patients in the standard long-course radiotherapy group will receive 50 Gy in 25 fractions, once daily, five days per week, with concurrent oral capecitabine chemotherapy. Target volumes will be delineated according to the 2023 Guidelines for Target Volume Delineation and Planning of Rectal Cancer (National Cancer Center/National Cancer Quality Control Center), including the primary tumor, mesorectal region, and internal iliac and obturator lymph node drainage areas.

Standard long-course radiotherapy

Two weeks after the completion of radiotherapy, patients will receive four cycles of CAPOX chemotherapy.

Chemotherapy

"Patients in the standard short-course radiotherapy group will receive 25 Gy in 5 fractions, once daily. Target volumes will be delineated according to the 2023 Guidelines for Target Volume Delineation and Planning of Rectal Cancer (National Cancer Center/National Cancer Quality Control Center), including the primary tumor, mesorectal region, and internal iliac and obturator lymph node drainage areas."

Standard short-course radiotherapy

Qing Yan

Participants in this arm will receive standard hypertension care along with access to the Decreased Salt High Potassium (DSHP) Diet Tool for 24 weeks and DSHP Patient information leaflet. The DSHP Tool is a patient-centered educational resource developed to support sodium reduction and increase potassium intake through practical strategies, goal setting, and food guidance. Participants will also receive the DSHP Patient Information Leaflet (PIL). Patients will be guided on how to use the tool by a study coordinator. Clinical and dietary assessments will be conducted at baseline and at the end of the intervention.

Participants in this arm will receive standard hypertension care and the Decreased Salt High Potassium (DSHP)Tool for 24 weeks. The DSHP Tool is an educational resource which includes a sodium intake calculator and tracker, potassium-rich food lists, risk matrix visuals, goal-setting modules tailored to the Singaporean diet. Participants will also receive the DSHP Patient Information Leaflet (PIL) .

Decreased Salt High Potassium Tool (DSHP Tool)

Participants in this arm will receive standard hypertension care as provided at SingHealth Polyclinics, along with the DSHP Patient Information Leaflet (PIL). The PIL provides written guidance on reducing sodium and increasing potassium intake. No access to the DSHP Tool will be provided in this arm. Participants will undergo the same clinical and dietary assessments as the intervention group at baseline and after 24 weeks.

암 환자들에게 기존 면역치료보다 적은 양의 치료가 효과적일지 확인하여 비용 절감과 삶의 질 향상을 연구하는 시험입니다.

Reduced dose intensity of IO:

IO will be administered every 3 months (at the same dose levels) until disease progression, unacceptable toxicity, death or patient's choice or investigator's decision

After 6 months of treatment with standard IO, IO will be administered every 3 months (at the same dose levels) until disease progression, unacceptable toxicity, death or patient's choice or investigator's decision

Reduced dose intensity of IO

Standard IO:

Continuation of IO at the same dose levels and rhythmicity until disease progression, unacceptable toxicity, death or patient's choice.

IO 용량 강도 감소:

IO는 질병 진행, 허용할 수 없는 독성, 사망 또는 환자 또는 연구자의 결정이 있을 때까지 3개월마다 (동일한 용량 수준으로) 투여됩니다.

IO의 감소된 복용량 강도

표준 IO:

질병 진행, 용납할 수 없는 독성, 사망 또는 환자의 선택에 따라 동일한 용량 수준과 주기로 IO를 지속합니다.

Elouen BOUGHALEM

Werner HILGERS

Louis FRANCOIS

Charlotte DOMBLIDES

Guillaume MARIE

Pierre-Emmanuel BRACHET

감소된 영역 단기 방사선 치료, 화학 요법과 결합된 면역 요법, 표준 단기 방사선 치료, 표준 장기 방사선 치료, 화학 요법

감소된 소금 고칼륨 도구(DSHP 도구)

표준 IO 투여 후 6개월이 지난 환자를 대상으로 3개월마다 동일한 IO를 투여한 경우와 표준 IO 투여를 비교한 연구